The Dysfunction of Headache Diagnoses and the Path to Relief

Does migraine surgery work for daily persistent headaches? What about for new daily persistent headaches? How about for chronic daily headaches? Migraines? Tension headaches? So many diagnoses behind the pain of severe headaches, you can get a migraine just thinking about it. Short answer to all of the questions above is “Yes.” Additionally, nerve decompression, or “Migraine Surgery” often also works for post-traumatic headaches, cluster headaches, and certainly works for occipital neuralgia. But how and why?

Most of the above diagnoses, except for occipital neuralgia, refer to the timing, onset, symptoms or frequency of headaches, not to their cause. While the cause of these headaches MAY be variable, we are learning that the root cause of many if not most of the headaches in all of these diagnoses is the irritation of the nerves in the forehead, temple, and back of the neck. As such, decompression of these nerves during the short outpatient procedure that is “Migraine surgery” can often be curative, but nearly always provides substantial pain relief.

Over the last many years, codification and the different diagnoses has become very important in the categorization of diseases. Doctors and hospitals need these diagnoses and codes in order to bill insurance companies and enable reimbursement. Additionally, some of the differences in frequency and symptoms that we see with different diagnoses may drive treatment, since much of headache treatment is geared toward relief of the symptoms associated with the headaches (pain, nausea, etc.) rather than geared toward the root cause of the pain. Migraine patients often suffer from nausea, for example, and they may require drugs called “anti-emetics” to help with this symptom. Tension headaches may be associated with anxiety, and drugs specific to this associated issue may be indicated in tension headache patients. But patients who suffer from BOTH of these symptoms most often have nerve compression of the occipital nerves that are addressed with nerve decompression surgery, and so this procedure helps both sets of patients.

Chronic daily headache, new chronic daily headache, and daily persistent headache all refer to the timing of the head pain. As the nerves above the eyebrow or in the back of the head and neck get irritated, early on, the diagnosis of new chronic daily headache may be made. As this persists, that patient who sees their neurologist after 6 months of pain many get a diagnosis of daily persistent headache or chronic daily headache. The root cause is the same, and therefore a single patient may actually harbor several different diagnoses over the course of the years of headache pain. But the common cause remains the same- irritated nerves that need to be surgically decompressed.

So by now I hope there is an understanding that the different diagnoses, like the branches of a tree, are often tied to the same root cause- compression and irritation of the nerves in the forehead, temple, neck, and back of the head. How can we fix this with nerve decompression surgery? During this procedure, also called migraine surgery, a small incision is made in the upper eyelid (the same incision that we use for eyelid “lifts” so it is very well hidden). Dissection is performed to find the Supra-orbital and Supra-trochlear nerves that are often compressed by some bone from the eye socket, connective tissue, blood vessels, and the muscles of the brow. If the pain is from the back of the head, and incision within the hairline is used to find the occipital nerves that can similarly be irritated by tight neck muscles, as well as blood vessels and connective tissue. In either case, the nerves are freed from the pressure of the tissues that are irritating them, and they no longer send the distress signals to the brain that cause the headache pain and symptoms. Surgery takes about 2-3 hours and patients go home or stay overnight at a hotel, and recovery is usually a few short weeks to headache relief (though the headache pain relief is often immediate.). Again, the pain and symptoms can be diagnosed as chronic daily headaches, migraines, new daily persistent headaches, tension headaches, or a multitude of other headache syndromes, but the key is that all of these diagnoses are caused by the same issue- irritated nerves.

There is no ambiguity about our ability to provide relief to patients who suffer from these headache disorders. Patients are seen for a consultation first, and specific nerve blocks are done in such a way to provide immediate though temporary relief from the headache pain. These nerve blocks are temporary and done for the purpose of diagnosis, not definitive treatment of the headache. Unfortunately, it is important that the diagnostic blocks are done by a migraine surgeon specifically, as many patients who have failed nerve blocks in the past respond quite well to the diagnostic blocks of a migraine surgeon, and thus turn out to be great candidates for nerve decompression migraine surgery. In fact, most of our patients have failed nerve blocks from other doctors, including those patients who tell their stories here.

If you have migraines or tension headaches, chronic daily headaches or post traumatic/whiplash headaches in Los Angeles, San Diego, Denver, or any of the surrounding regions and can make a trip to our Santa Barbara or Denver offices, call 805-969-9004 and make an appointment to discuss your case and the opportunity for permanent headache relief. If you have chronic headaches or migraines of any kind and live farther away from our Centers, call the office and our staff will arrange a consultation call to help figure out your headaches and get you the improvement you deserve.